https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Freiburg Universitäts-Herzzentrum, Klinik für Kardiologie und Angiologie Freiburg, Deutschland; 2Universitätsklinikum Freiburg Institut für Medizinische Biometrie und Statistik Freiburg, Deutschland
Background: Peripheral artery disease in transcatheter aortic valve replacement (TAVR) patients often results in the choice of an alternative access route, such as transapical, which is associated with a higher rate of complications. Several studies have shown a worse outcome for the transapical access in the overall population of all TAVR patients. However, so far there is little evidence of the Germany-wide outcome of TAVR patients suffering from peripheral artery disease.
Methods: All 8,934 TAVR procedures for aortic valve stenosis in patients with peripheral artery disease in 2019-2022 in German hospitals were analysed. In-hospital mortality and in-hospital complications were compared for transfemoral vs transapical TAVR.
Results: The baseline characteristics of 7,419 transfemoral and 1,515 transapical TAVR procedures showed that patients in the transfemoral group were older with 80.5 vs 78.8 years (p<0.001) and had a comparable logistic EuroSCORE of 21.6 and 21.7% (p=0.635). Patients treated with a transfemoral TAVR showed lower rates of in-hospital mortality of 3.1 vs 5.9% (p<0.001), major bleeding of 3.0 vs 7.0% (p<0.001), acute kidney injury of 13.5 vs 15.8% (p=0.020), postoperative delirium of 9.1 vs 16.8% (p<0.001), mechanical ventilation >48h of 2.5 vs 6.5% (p<0.001), and pericardial tamponade of 0.7% vs 2.2% (p<0.001) as well as a shorter length of hospital stay of 12.0 vs 16.4 days (p<0.001). However, there was a higher rate of permanent pacemaker implantations of 13.0 vs 9.0% (p<0.001). After risk adjustment, results largely persisted: Patients in the transapical group had a higher causal risk ratio (RR) for in-hospital mortality (RR=1.70, p<0.001), major bleeding (RR=2.23, p<0.001), postoperative delirium (RR=1.89, p<0.001), mechanical ventilation >48h (RR=2.05, p<0.001), and pericardial tamponade (RR=3.04, p<0.001) as well as a longer length of hospital stay (coefficient = 4.02 days, p<0.001). However, there was a lower risk of permanent pacemaker implantations (RR=0.70, p=0.010).
Conclusion: Patients with peripheral artery disease treated with transfemoral TAVR showed lower in-hospital mortality and overall complication rates. These results support the assumption that a transfemoral access should also be preferred in patients with peripheral artery disease if suitable.